EXAM 3 - Neurodevelopmental Disorders Flashcards
Diagnosed first
in infancy, childhood, or adolescence
Neurodevelopmental Disorders Include the following:
Attention deficit hyperactivity disorder Specific learning disorder Autism spectrum disorder Intellectual Disability Communication and Motor Disorders
Scope of learning disorders
Academic problems in reading, mathematics, and/or writing
Performance is substantially below expected levels based on age and/or demonstrated capacity
Problems persist for 6+ months despite targeted intervention
impairment in reading
Dyslexia
Dyslexia may include
Word Reading Accuracy Decoding (Phonological Awareness) The most common form of “dyslexia” Reading fluency (rate) Reading comprehension It is not reversing the order of letters!
impairment in written expression
dysgraphia
dysgraphia may include
Graphomotor
Spelling accuracy
Grammar punctuation and accuracy
Clarity/organization of written expression
impairment in mathematics
Dyscalculia
Dyscalculia may include
Number sense
Memorization of arithmetic facts
Accurate or fluent calculation
Accurate math reasoning
Prevalence of learning disorders
6.5 million children have been diagnosed in the United States
Highest rate of diagnosis in wealthier regions, but children with low SES more likely to have difficulties
Reading difficulties most common, affect 4-10% of the general population
Students with learning disorders are more likely to
Drop out of school Be unemployed Have suicidal thoughts Have negative school experiences May be related to communication disorders
Causes of Specific Learning Disorder
Genetic and neurobiological contributions
Learning disorders run in families
Evidence for subtle neurological difficulties is mounting (e.g., decreased functioning of areas responsible for word recognition)
Overall, contributions are unclea
Causes of Specific Learning DisorderPsychosocial contributions are likely important
Some languages more difficult to read > higher rates of reading impairment Motivational factors Socioeconomic status Cultural expectations Parental interactions Child management practices
Treatment of Specific Learning Disorder
Requires intense educational interventions Data support behavioral educational interventions Biological interventions (e.g., Ritalin) usually used only for those individuals who also have ADHD
Autism Spectrum Disorder
In DSM-5, it is categorized as a Neurodevelopmental Disorder
Problems occur in language, socialization, and cognition
Pervasive – problems span many life areas
Two main areas of impairment:
Communication and social interaction
25% don’t acquire effective speech
Restricted, repetitive patterns of behavior, interests, or activities
Autism Spectrum Disorder
Label is new to DSM-5 Encompasses several disorders previously classified as “pervasive developmental disorders” Including: Autistic disorder Asperger’s disorder Childhood disintegrative disorder Rett syndrome
Autism Spectrum Disorder-Three levels of severity
Level 1— “Requiring support”
Level 2— “Requiring substantial support”
Level 3— “Requiring very substantial support”
Described qualitatively and, as yet, has no quantitative equivalent
With and Without Intellectual Impairment
Catatonia is an additional qualifier
DSM5 Autism Spectrum Disorder
Diagnostic Criteria
A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive, see text):
- Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
- Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
- Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.
Specify current severity: Severity is based on social communication impairments and restricted repetitive patterns of behavior. (See table below.)
B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive; see text):
- Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
- Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
- Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interest).
- Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).
Specify current severity: Severity is based on social communication impairments and restricted, repetitive patterns of behavior. (See table below.)
C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.
Impairment in Social Communication and Interaction
Failure to develop age-appropriate social relationships
Trouble initiating and maintaining relationships
Trouble with nonverbal communication
May lack appropriate expressions, tone
Trouble with social reciprocity
Deficits in joint attention – the ability to communicate interest in an external stimulus and another person at the same time
Severe forms:Stereotyped or ritualistic behavior
E.g., spinning, waving hands, rocking
Less severe forms: Intense, circumscribed interest in very specific subjects
Having restricted areas of interest may compound difficulties relating to others
Autism Spectrum Disorder: Prevalence
Previously thought to be very rare, but this is not the case
1 in 50 school-aged children meet criteria
More commonly diagnosed in males
Gender ratio: 4-5:1
IQ interaction
38% show intellectual disabilities
Occurs worldwide
Psychological and Social Dimensions of Autism - Historical views
Failed parenting
Perfectionistic, cold, and aloof
Parents thought to have high socioeconomic status and higher Iqs
This view is not true
Originally thought to be lack of self-awareness
Later, many individuals with ASD shown to have intact awareness of self
Biological Dimensions/Etiology of Autism
March 2002, NIMH began a 5 year, $6 million grant to identify genetic markers
The Autism Genetic Resource Exchange (AGRE) gene bank is collecting information
This is a brain disorder that children are born with
Concordance rates vary from 60 to 95% for MZ twins (If autism isn’t present, learning disabilities in language or a social disorder are present)
Biological Dimensions - Significant genetic component
Familial component: If you have one child with autism, the chance of having a second child with autism is 20% (100x greater risk than general population)
Numerous genes on several chromosomes involved
Oxytocin receptor genes
Bonding and social memory
Older parents associated with increased risk
Biological Dimensions of Autism - Neurobiological influences
Amygdala
Larger size at birth = higher anxiety, fear
Elevated cortisol
Neuronal damage in the amygdala results from high stress, which may affect processing of social situations
Oxytocin
Lower levels in individuals with ASD
Limbic System and Cerebellum (too many cells and smaller in the limbic system)
May be that brain growth is unusually rapid at age 2 or 3 and then arrested
This would results in cerebral and cerebellar brain volume being smaller at older ages
Prenatal illness may predispose child
Biological Dimensions - Neurobiological influences
Vaccinations do NOT increase the risk of autism
Mercury and preservatives in some vaccinations was rumored to increase autism risk
Large scale studies do NOT support this
High rates of vaccinations do NOT increase risk for autism in the community at large
Health risk of not vaccinating is substantial
Treatment of Autism Spectrum Disorder - Psychosocial treatments
Behavioral approaches Skill building Reduce problem behaviors (“ABA”) Communication and language training Increase socialization Emotion identification and recognition Early intervention is critical
Treatment of Autism Spectrum Disorder - Biological treatments
Medical intervention has had little positive impact on core dysfunction Some drugs decrease agitation Tranquilizers SSRIs Indicators of good prognosis High IQ, good language ability
Treatment of Autism Spectrum Disorder - Integrated treatments
Preferred model: Multidimensional, comprehensive focus
Children offered special education at school focusing on communication
Judicious use of medication in some cases
Families given support too
When older, focus on integrating into the community while maximizing independence
Comprehensive Treatment Programs for ASD
Behavior Modification is used to teach a variety of skills along with speech therapy and occupational and physical therapy
TEACCH (U. of N. Carolina) focuses on developing the child’s communication (doesn’t necessarily have to be verbal) and social interaction skills.
Lovaas’s approach (UCLA) focuses on using intensive operant conditioning (often criticized for use of aversives although it’s not necessary to use these)
Intellectual Disability (Intellectual Development Disorder)
Impaired Intellectual Functioning
Impaired Adaptive Functioning
Must have both impairments for ID
Standard scores on both assessments at or below 70 (Remember average functioning ranges from about 90 to 109)
Was previously an Axis II diagnosis in the DSM
Intellectual Disability: Statistics
Prevalence = 2% of general population
9 in 10 people with ID have mild impairment (IQ 50-70)
Chronic course
Highly variable individual prognosis
Independence is possible for many individuals with mild impairment when provided with appropriate resources (e.g., skills training)
DSM-5 identifies difficulties in three domains of Intellectual Disability
Conceptual (e.g., skill deficits in areas such as language, reasoning, knowledge, and memory)
Social (e.g., problems with social judgment and the ability to make and retain friendships)
Practical (e.g., difficulties managing personal care or job responsibilities)
DSM5 Diagnostic criteria for intellectual disability
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